Implantation
Pacemaker and ICD Implatation
Pacemaker Implantation
A pacemaker is a small battery-powered device that helps the heart beat at a regular rhythm. When heart muscle cells are damages so that the electrical rhythms to the heart are interrupted, delayed, or sent down the wrong path, the heart rate may become irregular, too fast, or too slow. In cases such as these a pacemaker may be required.
When is a Pacemaker Indicated?
A pacemaker may be appropriate in the following situations:
- People with temporary, intermittent, or persistent conditions that interfere with their heart’s ability to initiate or properly distribute electrical signals (atrial fibrillation, atrial flutter, A-V block).
- People with congenital or acquired heart problems that result in a heartbeat slower than 60 beats per minute (bradycardia), or a rapid and irregular heart beat (tachyarrythmia).
- People who have experienced heart damage as a result of a viral infection.
- People receiving drug therapy for other heart conditions – like betablockers for bradycardia.
- People who have recurrent fainting or syncopal episodes.
Pacemakers come in two forms, temporary and permanent. Short-term problems that are a result of issues like a heart attack, heart surgery or a medication overdose may be treated with a temporary pacemaker. Permanent pacemakers are used for individuals with ongoing or long-term heart conditions.
How Does a Pacemaker Work?
A pacemaker is powered by a small battery called a generator. Attached to the generator are wires called electrodes or leads, which will be placed inside the heart. The device is programmed so that the leads communicate with the generator to stimulate the heart as programmed by the physician.
What Happens During the Implant Procedure?
A temporary pacemaker is an external device. It is usually done while a patient is in the hospital for a related heart condition. The procedure can take place at the patient’s bedside. The patient is typically given some type of sedative, then the puncture site (either the neck or groin) is cleaned to prevent infection, and a local anesthetic is injected at the insertion site. A catheter is then placed into a vein and threaded into the heart, where its metal tip will stimulate heartbeats. The catheter is secured so that it will not be accidentally dislodged.
The implantation of a permanent pacemaker is considered a minor surgical procedure, and is typically done in an inpatient or outpatient surgical area. Sedation and locale anesthetic is given to the patient, and the skin just below the collarbone on the left side of the chest is cleaned and shaved. The physician then makes a small pocket just under the skin of the chest wall, and inserts the generator. The wires or leads that are attached to the generator are then placed into the a large vein in the upper chest and passed to the right atrium or the right ventricle. Small tines or screws are used to secure these leads to the inner surface of the heart. The skin incision is then closed with sutures or staples.
After the Procedure
Please follow this link for information on home instructions for Patients with Pacemakers.
Implantable Defibrillator Therapy
What is an implantable defibrillator?
An implantable defibrillator is a pacemaker-like device that has been available since the early 90’s. It’s small - about the size of a pager - and is implanted under the skin in your upper chest. The battery and computer circuitry needed to correct your heart rhythm are contained in the device. Thin insulated wires, called leads, connect the implantable defibrillator to your heart. If the device detects a problem with your heart rhythm, it will use electrical signals to correct your heart rate. Most implantable defibrillators last 5-7 years before requiring replacement.
When is the procedure indicated?
In general, most people who are candidates for an implantable defibrillator have one or more of the following risk factors:
- have heart failure (heart failure is a condition that reduces the heart’ ability to pump blood).
- have had a heart attack.
- have a family member who has experienced sudden cardiac arrest.
- have a low ejection fraction (this means that your heart is no longer pumping efficiently and may not be able to supply your body and brain with enough blood).
How does an implantable defibrillator work?
Depending on how it’s programmed, an implantable defibrillator can first use small, painless electrical signals to correct your heart rate. If these don’t work, a stronger shock is delivered. People describe the shock as being surprising and uncomfortable, sometimes even painful, but the feeling passes quickly. Quite often it’s over before you are fully aware of what happened. The good news is that your implantable defibrillator is continually there monitoring and protecting you, 24 hours a day.
What happens during the implant procedure?
Typically, the implant procedure is quick, low risk, and usually done under local anesthesia. It does not require open-heart surgery, and most people go home within 24 hours.
Patients are normally sedated throughout the procedure and do not feel any pain. Your doctor will make a small incision in the upper chest and guide the leads through a vein and into your heart. Your doctor will then connect the leads to the implantable defibrillator and program the device. Then the implantable defibrillator will be inserted beneath the skin and the incision in your chest will be closed. Your physician will test the implantable defibrillator to ensure it is working properly.
After the procedure
Following the device implant, people typically stay in the hospital overnight and go home the next day. You will see a small bump under your skin where your device is located and it may be tender. Generally, you should limit arm movement on the side of your device for about 2-6 weeks. Your doctor will provide you with more specific care instructions, but you can expect to gradually return to your everyday activities shortly after the procedure. If you have any questions, please ask your doctor or nurse.